Gastrosplenic Ligament Splenorenal Ligament Phrenicocolic Ligament

The peritoneal reflections in the left upper quadrant of the abdomen are shorter but are certainly no less important in providing avenues of spread of disease. Anatomic continuity between multiple sites is readily established.

The gastrosplenic ligament is continuous with the gastrocolic ligament and extends from the greater curvature of the stomach to the spleen (Fig. 4-63). It con tains the left gastroepiploic and short gastric vessels as well as associated lymphatics. The splenorenal ligament (Fig. 4-63) invests the extremity of the pancreatic tail as it inserts toward or within the splenic hilus and also contains the distal splenic artery. Both ligaments form the boundaries of the lesser sac on the left.

The gastrosplenic ligament is identified on CT by its fat and vascular content at the site between the stomach and spleen (Figs. 4-4 and 4-64): It may be arranged into longitudinal pleats or a series of ruffles.67,68 Radiologic localization of disease spread here can be very precise (Fig. 4-65) and is particularly helpful in the evaluation of extramural spread of gastric malignancies (Figs. 4-66 through 4-68). A tract may be formed in the gastro-splenic ligament to enable spread from the stomach to the development of a splenic abscess (Figs. 4-69 and 470). Although neoplasm in a contiguous organ has been considered a rare cause of splenic abscess in the past,69 this pathogenesis is being increasingly recognized by CT. Continuity with the splenorenal ligament allows spread of disease between the stomach, spleen, and tail of the pancreas (Figs. 4-71 and 4-72). This short ligament is

Fig. 4—47. The transverse mesocolon.

(a) CT scan shows middle colic vessels branching in the fatty space between the uncinate process (U) and body of the pancreas (P) and the transverse colon (T). D = duodenum. Some ascites is present adjacent to the liver and spleen. (Reproduced from Meyers et al.9)

(b) In a contrast-enhanced CT in another patient, the fat-laden plane of the transverse mesoco-lon is signalled by the opacified middle colic vessels. T = transverse colon.

Phrenicocolic Ligament

Fig. 4—48. Hematoma of the transverse mesocolon, demonstrating its extent and relationships in vivo.

(a) At the level of the celiac axis, a mass of fluid density (arrows) extends throughout the mesocolon from the anterior hepatic flexure (HF) on the right to the splenic flexure (SF) on the left and to the anteriorly displaced transverse colon.

(b) At the level of the third portion of the duodenum (D3) and the superior mesenteric vessels, the mesocolic hematoma— containing areas of heterogeneous increased attenuation—extends to the anatomic splenic flexure of the colon (C). A middle colic vessel is seen (arrow). Hemoperitoneum is also present.

(Courtesy of Gary Ghahremani, M.D., Evanston Hospital, Evanston, IL.)

Fig. 4—48. Hematoma of the transverse mesocolon, demonstrating its extent and relationships in vivo.

(a) At the level of the celiac axis, a mass of fluid density (arrows) extends throughout the mesocolon from the anterior hepatic flexure (HF) on the right to the splenic flexure (SF) on the left and to the anteriorly displaced transverse colon.

(b) At the level of the third portion of the duodenum (D3) and the superior mesenteric vessels, the mesocolic hematoma— containing areas of heterogeneous increased attenuation—extends to the anatomic splenic flexure of the colon (C). A middle colic vessel is seen (arrow). Hemoperitoneum is also present.

(Courtesy of Gary Ghahremani, M.D., Evanston Hospital, Evanston, IL.)

Phrenicocolic Ligament AscitesDuodenocolic Ligament

Fig. 4—49. Spread of pancreatic carcinoma into transverse mesocolon.

In two different patients (a and b), arrows show extension of carcinoma of the uncinate process (U) and the body of the pancreas (M) as stellate and dendritic infiltrations of the transverse colon (TC). (a, courtesy of Nancy O. Whitley, M.D., University of Maryland School of Medicine, Baltimore.)

Fig. 4—49. Spread of pancreatic carcinoma into transverse mesocolon.

In two different patients (a and b), arrows show extension of carcinoma of the uncinate process (U) and the body of the pancreas (M) as stellate and dendritic infiltrations of the transverse colon (TC). (a, courtesy of Nancy O. Whitley, M.D., University of Maryland School of Medicine, Baltimore.)

identified less frequently by CT, but is generally indicated after intravenous contrast injection by the distal splenic artery or the proximal splenic vein.

The phrenicocolic ligament (Fig. 4-73a) extends from the anatomic splenic flexure of the colon to the diaphragm at the level of the 11th rib48 and serves to support the spleen in the left upper quadrant. It is in most direct continuity with the splenorenal ligament and the transverse mesocolon. It can be identified occasionally on plain films48 and clearly by peritoneogra-phy,70 and on CT in cases of ascites it may be outlined in its characteristic position (Fig. 4-73b). The avenue of spread facilitated by the ligament's relationships explains the predisposition of carcinoma of the tail of the pan creas to involve the anatomic splenic flexure of the colon (Figs. 4-74 and 4-75).

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Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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Responses

  • Diana
    Is the gastrosplenic ligament near the splenic flexure of the colon?
    3 years ago

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